Paradigm Shift in Women’s Postpartum Health: The Fourth Trimester

This summer, radical new clinical guidelines in women’s postpartum health issued by the American College of Obstetricians and Gynecologists (ACOG) shivered the spines of traditional model of postpartum care by designating the highly critical postpartum period (following pregnancy and delivery) as the “Fourth Trimester.”  This new position serves both as firm advocacy and medical warrant for more specialized, comprehensive care for pregnant and postpartum women, periods which have critical implications for female long term health and wellness.   Most fittingly, these recommendations include the important role of women’s health physical therapy in postpartum care.

For females who have been pregnant (or any human remotely knowledgeable about/empathetic to this journey), we need not reach far to acknowledge the significant, multi-system changes that occur during those nine months — and notably, the days, months, years into decades thereafter.   During pregnancy, remarkable changes occur throughout our brain and interrelated bodily systems – musculoskeletal, nervous, endocrine (hormonal), immunological, gastrointestinal, urological, integumentary (skin/breasts), psychiatric, cardiovascular, respiratory, reproductive, hematological/lymphatics (blood/lymph).   And, it’s hardly rocket science that these significant systemic changes require more than 6 weeks to re-adjust/find new baselines following delivery -– and moreover, often have grave implications on longer term health outcomes if not addressed timely and appropriately.

How many of our selves, mothers, grandmothers and fellowest females experiencing bodily changes and related difficulties following pregnancy have been told “it’s just how it is” after having a baby? In the US, standard of post-delivery follow up occurs at 6 weeks, a slightly arbitrary and inadequate timing/measure of the true scope of a woman’s postpartum health.  Studies estimate over 50% of pregnancy-related deaths happen AFTER birth in the US.  Postpartum care across the pond(any ‘pond,’ really – Europe, Australia, many other cultures/regions) prioritize postpartum health with ongoing care and community support for months and years thereafter.

It’s high time that we catch up:  ACOG’s new guidelines are a welcomed and more holistic shift toward more comprehensive care for postpartum women.   These recommendations include:

  • Postpartum care should be more than one visit and be individualized to suit each patient’s  needs.
  • Initial follow up visits should be within 3 weeks and not not to exceed 12 weeks postpartum
  • More comprehensive, multi-disciplinary care addressing physical health and pain (PT!),  psychological well-being, emotional health, feeding issues, sexuality, contraception, birth spacing, among other difficulties.
  • Special coordinated care for patients with chronic medical conditions – high blood pressure, diabetes, thyroid issues, kidney issues, mood disorders
  • A critical shift at the policy level (factoring into recognition/updates of regulations, insurance, medical providers, organizations and the patient)

As PTs, we have excellent resources and ample scientific research in support of making positive changes for women who are pregnant, in their “Fourth Trimester” and those beyond the initial postpartum stage.  We are in a valuable position to address a wide scope of pregnancy and postpartum issues, including low back/hip pain, pelvic pain, painful intercourse, urinary incontinence (stress or urge), constipation/straining, pelvic organ prolapse, rectus diastasis (abdominal weakness and separation), abdominal scarring/incisions with integration into graded return to exercise, lifestyle strategies/modifications and restoring quality of life and support.

So, here’s to a much-needed, newly-named frontier:  May the “Fourth” be with you!

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